Objective To investigate the neutrophil elastase (NE) in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).Methods Thirty-six patients of ALI/ARDS and 16 healthy volunteers(control group)were involved in the study.The patients of ALI/ARDS were divided into three groups:group A (the oxygenation index was 201-300 mm Hg,1 mm Hg=0.133 kPa),group B (150-200 mm Hg),and group C (<150 mm Hg).The NE in serum and bronchoalveolar Lavage fluid (BALF) were measured.Results The NE in the serum and BALF in group A [(1.76±0.63)nmol/L and (1.67±0.59)nmol/L],group B [(3.26±0.51)nmol/L and (3.64±0.56)nmol/L] and group C [(4.56 ±0.68)nmol/L and (4.62±0.39)nmol/L] were much higher than that in control group [(0.67±0.54)nmol/L and (0.62±0.48)nmol/L].The NE in the serum and BALF of dead patients were higher than that in patients who were alive.Moreover,the NE in the patients of ALI/ARDS was inversely related to the oxygenation index (r=-0.901,P＜0.01). Conclusion The NE in patients of ALI/ARDS is higher than that in healthy people,and it is significantly related to the severity and the prognosis of ALI/ARDS.

Objective To investigate the diagnostic value of serum Cystatin C and 24 h urine microalbumin quantitative exami-nation in the early gestational diabetes kidney.Methods Chose 110 cases of patients from 37 to 40 weeks during pregnancy with gestational diabetes.According to the GFR,patients were divided into GFR moderate decline group A (30 ml/min/1.73m2 ≤GFR<60ml/min/1.73m2 ,n=30),GFR mild decline group B (60 ml/min/1.73m2 ≤GFR<89 ml/min/1.73m2 ,n=42)and GFR normal group C (GFR≥90 ml/min/1.73 m2 ,n=38).Choose the same gestational weeks 40 healthy preg-nants cases as control group D.Statistics of four groups of serum Cys C,24 h urine microalbumin quantitative,serum urea and creatinine,then analize.Results The levels of serum cystatin C and urine microalbumin compared between each group respectively,the differences were statistically significant (F=31.209,34.698,P <0.01,respectively).The levels of blood u-rea and creatinine in group A when compared with the other groups,found that the difference was statistically significant (F=5.845,4.575,P <0.01,respectively).When comparing the levels of blood urea and creatinine among the groups B,C and D,there was no statistical difference of significance (P >0.05).There was positive correlation between levels serum Cys C and urine microalbumin in group A and B (r=0.756,0.725,t=5.209,4.835,P <0.01,respectively).The sensitivity of Cys C and urine microalbumin were 95.2% and 90.5%,sensitivity of the combination of Cys C and urine microalbumin was 100% (χ2 =8.24,7.08,P <0.05,respectively).Conclusion As sensitive indicators of gestational diabetes in the early renal damage stage,joint detection of Cys C and urine microalbumin is of great significance for diagnosis and monitoring of diabe-tes in the early renal damage stage.

BACKGROUND:Grape seed extract has been shown to be effective in inhibiting the growth of androgen-dependent tumors(e.g.,breast cancer),and thus grape seed extract could theoretically inhibit epiphyseal closure induced by estrogen in late adolescence. OBJECTIVE:To screen the effects of grape seed extract on apoptosis of growth plate chondrocytes and epiphyseal closure in rats. METHODS:(1)In vitro experiment:Growth plate chondrocytes from rat large tibia and femur at logarithmic growth stage were obtained and cultured in groups:normal control group,model control group(adding 17β-estradiol to induce apoptosis),positive control group(adding letrozole and 17β-estradiol),grape seed extract group(adding 17β-estradiol and 10 μg/mL grape seed extract),Caspase-9 inhibitor group(adding 17β-estradiol and Caspase-9 inhibitor),Caspase-9 agonist group(adding 17β-estradiol and Caspase-9 agonist).Cell apoptosis was detected by flow cytometry after 48 hours of culture.(2)In vivo experiment:Thirty 3-month-old Sprague-Dawley rats were randomly divided into model control group,positive control group and low-,medium-and high-dose groups,with five rats in each group.All rats were injected subcutaneously with 17β-estradiol(3 times per week)to establish epiphyseal closure models,followed by intragastric administration of letrozole in positive control group and 0.05,0.2 and 0.8 g/kg grape seed extract in low-,medium-and high-dose groups,respectively,once a day until over 2/3 of the epiphyseal plate in the model control group was closed.The length of the tibia was then observed.Another 18 Sprague-Dawley rats were randomly divided into model control group,positive control group,and medium-dose group,with 6 rats in each group,treated as above for 1.5 continuous months.The expression of Caspase-9 protein in rat growth plate cartilage was detected by western blot. RESULTS AND CONCLUSION:(1)In vitro experiment:17β-estradiol could induce apoptosis in growth plate chondrocytes,and letrozole,grape seed extract,and caspase-9 inhibitors could all inhibit apoptosis in growth plate chondrocytes.(2)In vivo experiment:When more than 2/3 of the epiphyseal plate in the model control group was closed,the number of rats with epiphysis closure in the positive control and medium-dose groups was less than that in the model control group(P＜0.05),and the tibial length was longer than that in the model control group(P＜0.05),and the Caspase-9 protein expression in the tibial growth plate was lower than that in the model control group(P＜0.05).To conclude,the appropriate dose of grape seed extract can effectively inhibit the apoptosis of growth plate chondrocytes and delay epiphyseal closure,which has the potential to promote bone growth.

Modern medicine has made remarkable achievements in safeguarding people's life and health, however, it is increasingly found that in the face of complex diseases, selective targeting of single target is often difficult to produce a comprehensive rehabilitation effect, and is prone to induce drug resistance, toxic side effects. Traditional Chinese medicine (TCM) has a long history of clinical application, and its clinical value in the treatment of complex diseases such as cardiovascular and cerebrovascular diseases, digestive diseases, skin diseases, rheumatism and immunity diseases, and adjuvant treatment of tumors has been proven to have obvious advantages. However, its modern research is relatively lagging behind, and in the face of the aging society and the characteristics of the modern disease spectrum, the traditional knowledge-driven research paradigm seems to be stuck in a bottleneck and difficult to make greater breakthroughs. Focusing on the key issues of TCM development in the new era, the clinical value-oriented strategy becomes to be a new research paradigm of TCM inheritance and innovation development, and dominant diseases would be the focus of the TCM inheritance and innovation development, which has been highly valued in recent years by the TCM academia and the relevant national management departments. Based on the clinical value, a series of policies are formulated for the selection and evaluation of the TCM dominant diseases (TCMDD), and exploratory researches about the clinical efficacy characteristics, the modern scientific connotation interpretation were carried out. The clinical value-oriented research paradigm of TCMDD inheritance and innovation development has been initially formed, which is characterized by strong policy support as the guarantee, systematic and standardized selection and evaluation methods as the driving force, scientific and effective research on internal mechanisms as the expansion, and effective clinical guidelines and principles as the transformation, which is of great value in promoting the high-quality development of the industries and undertaking of TCM. In this paper, the main policy support, selection and evaluation methods, therapeutic effect characterization, and modern scientific connotation research strategies of TCMDD in recent years have been comprehensively sorted out, with a view to providing the healthy and benign development of the research on TCMDD.

Cognitive dysfunction is one of the common central nervous systems (CNS) complications of diabetes mellitus, which seriously affects the quality of life of patients and results in a huge economic burden. The glymphatic system dysfunction mediated by aquaporin-4 (AQP4) loss or redistribution in perivascular astrocyte endfeet plays a crucial role in diabetes-induced cognitive impairment (DCI). However, the mechanism of AQP4 loss or redistribution in the diabetic states remains unclear. Accumulating evidence suggests that peripheral insulin resistance target tissues and CNS communication affect brain homeostasis and that exosomal miRNAs are key mediators. Glucose and lipid metabolism disorder is an important pathological feature of diabetes mellitus, and skeletal muscle, liver and adipose tissue are the key target insulin resistance organs. In this review, the changes in exosomal miRNAs induced by peripheral metabolism disorders in diabetes mellitus were systematically reviewed. We focused on exosomal miRNAs that could induce low AQP4 expression and redistribution in perivascular astrocyte endfeet, which could provide an interorgan communication pathway to illustrate the pathogenesis of DCI. Furthermore, the mechanisms of exosome secretion from peripheral insulin resistance target tissue and absorption to the CNS were summarized, which will be beneficial for proposing novel and feasible strategies to optimize DCI prevention and/or treatment in diabetic patients.